Occupational Exposure to Surgical Smoke Poses Hidden Health Risks to OR Staff

University of Sao Paulo and the University of Alfenas, Brazil, presented a poster at AORN2025.

Surgical smoke, a byproduct of electrosurgical devices commonly used in operating rooms, presents a significant occupational hazard to perioperative professionals. A study, “Impact of the Surgical Smoke and Occupational Health in Operating Room Workers,” presented by a team from the University of Sao Paulo and the University of Alfenas, Brazil, at the 2025 AORN Global Surgical Conference & Expo in Boston, Massachusetts, held from April 5 through 8, explored the biological effects of exposure to this toxic aerosol on health care workers.

Generated during procedures using electrical scalpels, surgical smoke contains harmful chemical compounds such as benzene and xylene. Chronic exposure to these substances has been linked to oxidative DNA damage, disruptions in the cell cycle, and apoptosis of hematopoietic precursor cells. These molecular effects contribute to long-term health complications, including respiratory irritation and potential carcinogenic outcomes.

The study employed a cross-sectional, analytical, and descriptive approach to assess occupational exposure among 104 health professionals. Participants were divided into 2 groups: those working in operating and obstetric centers (exposed group) and those in non-clinical or non-operative settings (control group). Each participant completed a detailed questionnaire capturing sociodemographic data, lifestyle habits, comorbidities, and work-related variables. Urine samples were collected and analyzed for benzene, xylene, and oxidative stress biomarkers, including creatinine, catalase, superoxide dismutase, and urinary peroxides.

Results indicated a significantly higher presence of benzene and xylene in the urine of exposed professionals compared to the control group (P < 0.001). Additionally, those exposed exhibited greater urinary DNA damage and altered oxidative stress markers, pointing to increased cellular vulnerability. Workers who reported nasal irritation were typically exposed to surgical smoke for longer durations than their peers, underscoring the dose-dependent relationship between exposure and symptoms.

The findings support the conclusion that operating room professionals are at risk of cumulative biological damage due to regular exposure to surgical smoke. This exposure alters oxidative balance and can impair the body’s antioxidant defense mechanisms. These changes may be early indicators of more serious health effects if the exposure remains unchecked.

Regarding perioperative nursing implications, the study emphasizes that standard surgical masks do not adequately protect against inhalation of smoke particulates. This highlights the urgent need for facilities to implement effective smoke evacuation systems and educate staff on the risks and necessary protective measures. Monitoring oxidative biomarkers alongside occupational exposure markers could become a key component in safeguarding the long-term health of surgical personnel.

“Thus, the assessment of oxidative profile markers can be used complementary to biomarkers of occupational exposure to surgical smoke, perioperative nursing implications, the use of surgical masks does not protect from exposure to surgical smoke,” the authors wrote. “Thus, knowledge about the effective preventive measures to reduce exposure to surgical smoke reduces the risk of exposure and effects adherence to the recommended practices to control surgical smoke.”

This research advocates for stricter adherence to surgical smoke safety protocols and reinforces the vital role of perioperative nurses in leading workplace safety initiatives.